Arthroscopic Surgery

At the Cape Shoulder Institute, arthroscopic surgery, being a minimally invasive diagnostic and treatment procedure utilising a small, lighted, optic tube, is performed regularly.

Many procedures can be carried out utilising this technique, some of which may be undertaken in the consulting rooms using local anaesthesia, most often under ultrasound control. This method thus avoids the need for admission to hospital.

Open Surgery

Some operations can only be carried out through "open" incisions as it is not possible to perform them arthroscopically.

Examples of such operations are a shoulder replacement or the Latarjet stabilization operation. Every effort is made to reduce the scarring. Achieving maximum function with minimal pain is the aim of surgery.

Shoulder Publications

In this section you may view the national and international publications from Dr Joe de Beer and the Cape Shoulder Institute. The abstracts in the relevant journals will be shown. The full articles may be seen on the websites of the journals or in Pubmed.

Shoulder Problems / Acromio-clavicular (AC) Joint Dislocations

Definition

Os-acromiale is a loose / mobile acromion of the shoulder which may or may not cause pain. In the most cases the loose acromion may go undetected as it does not lead to any painful symptoms.

Anatomy

The acromion is a projection from the scapula (shoulder blade) and is located on the top and front (antero-superior) of the shoulder. It can be felt as a bony tip on the top of the shoulder. The acromion is like a “roof” over the rotator cuff. The acromion serves as the attachment of the deltoid muscle. The deltoid muscle extends from the acromion to the upper humerus and is a main elevator of the arm.

Background

All bones have growth plates until a person stops growing (about 18 years of age). The growth plate is a part of the bone which consists of cartilage and its cells which cause the bone to lengthen during growth are situated in this non-solid part of the bone. The os-acromiale is nothing else but a persistent growth plate meaning that the growth plate did not fuse when growth ceased. It does not cause the bone to continue growing but remains as a strong fibrous union which can be disrupted with some force.

Os-acromiale occurs in a small percentage of the population and only a small part of those individuals have pain. It may become painful in time or sometimes due to excessive overhead sports or even an injury.

X-Rays

On x-rays the mobile unfused bone can usually clearly be seen.

Symptoms

The pain is due to either motion of the bony fragment or due to the fact that this part of the bone then “impinges” on the underlying rotator cuff tendon.

It is therefore one of the causes of “impingement” of the rotator cuff. The doctor examining the patient would decide that this was impingement and then would have to make sure if the pain was from the bone itself or from the mobile segment impinging on the underlying tendon. This can usually be done by injecting local anaesthetic into the subacromial space (between the tendon and acromion (see injections) or under ultrasound control the local anaesthesia can be injected into the defect itself which would then lead to immediate pain relief proving the origin of the pain.

Management

The condition only needs to be treated if it results in pain which the patient cannot function with.

The different types of os-acromiale:

Pre-acromion:

A pre-acromion is a small piece and can usually be removed with arthroscopic surgery.

Pre-acromion type of os-acromiale:
small anterior loose part of the
acromion demonstrated.

The small anterior bony fragment is
removed with arthroscopic surgery.

Meso-acromion:

It is the most frequently occurring type. This segment of acromion is usually too large to be removed as it would lead to poor function of the important deltoid muscle which attaches to it. If the pain is due to irritation of the underlying cuff a small acromioplasty can be performed. Otherwise open reduction and internal fixation should be done – in our experience this has been a very successful procedure with return to normal function and no resulting pain in just about all the patients. Fixing the os-acromiale is the preferable mode of treatment rather than excising the fragment with all its potential complications.

Fixation of the loose acromial fragment which
will solidly unite to the rest of the acromion.

By reducing and fixing the acromion the
impingement on the under lying rotator cuff is relieved.